It’s one of the abiding ironies of policymaking that, once the policies are set, things arise that probably should have been thought of before.

According to a newarticle in the New England Journal of Medicine, one of those things, when it comes to EHRs, is patient safety.

The article’s authors propose that “at a time when institutions are focused heavily on achieving ‘meaningful use’ requirements . . . clearer guidance must be provided so that these institutions can align activities related to patient safety with the activities required to support a safe EHR-enabled healthcare system. A set of EHR-specific safety goals, modeled after the Joint Commission's National Patient Safety Goals, may provide organizations with areas of focus for sustained improvements in organizational infrastructure, processes, and culture as they adapt to new technology.”

Noting the “still highly heterogeneous” implementation of EHRs across the healthcare sector, they “propose a three-phase framework for the development of EHR-specific patient-safety goals (e-PSGs). The first phase of the framework, aimed at all EHR users but especially at recent and future adopters, includes goals to mitigate risks that are unique and specific to technology (e.g., technology that is unsafe owing to unavailable or malfunctioning hardware or software). The second phase addresses issues created by the failure to use technology appropriately or by misuse of technology. The final phase focuses on the use of technology to monitor health care processes and outcomes and identify potential safety issues before they can harm patients. This framework can lay the foundation for the development of e-PSGs within the context of EHR-enabled health care.”

From there, the authors proceed to unpack each of the phases of their framework, and it’s hard to argue with much of what they say. The main question, it seems to us, is how to proceed.

The authors recognize both the preliminary nature of their proposal – meaning it needs much more discussion – even as they note that the MU train has long since left the station.

So, assuming they’re on the right track, what’s the best way for policymakers and stakeholders to move forward?